Earlier this month, Vice President Mike Pence spoke at a gala for Susan B. Anthony's list, a powerful anti-abortion group. To rapturous applause, he gloated that President Trump had assembled an "A-Team" of "great pro-life leaders": Tom Price, who twice sponsored legislation that would give full constitutional rights to zygotes; Ben Carson, who once likened abortion to slavery; Rick Perry, who signed Texas' notorious abortion restrictions—which were eventually declared unconstitutional by the Supreme Court—into law.
Two new members have been recently welcomed to that team: Charmaine Yoest, the former head of Americans United for Life, and Teresa Manning, an outspoken anti-abortion activist. Both Yoest and Manning have been selected for leadership positions at the Department of Health and Human Services (HHS), the federal agency tasked with protecting the health of the American public; both are strongly opposed to abortion and several methods of contraception. The problem is not that Yoest and Manning have strong views on these subjects—it's that those views are not grounded in reliable evidence, and that both women have dedicated their professional lives to advocating for policies that aren't evidence-based, either. These appointments are a stunning example of what happens when willful ignorance gains a powerful platform.
Yoest, who will serve as the department's assistant secretary of public affairs, has made a career out of spreading false information, insisting that there's a link between abortion and breast cancer—despite the fact that this claim has been debunked by several leading medical organizations, including the American Cancer Society. She also claims that contraception doesn't reduce the abortion rate, and dismisses reliable evidence that contradicts her positions by claiming the entire scientific community is controlled by an "abortion lobby." She has clearly stated that she wants to make abortion illegal, even in cases of rape and incest.
Manning, who will oversee Title X, a family planning program that has provided contraceptive services to low-income and uninsured people for over 40 years, holds the peculiar and medically incorrect view that contraception doesn't actually work to prevent pregnancy. As a former lobbyist for the National Right to Life Committee, she has advocated against both intrauterine devices (IUDs) and emergency contraception on the grounds that they cause early abortions (they don't). She once remarked that family planning should be "what occurs between a husband and a wife and God."
In reflecting what these appointments might mean for actual people, I think of my patients. I remember speaking with a woman in the early days of the Zika crisis, when so much was unknown, who had traveled to a Zika-affected area and was terrified of the possibility of becoming pregnant before she could be certain she had not contracted the virus. IUDs, which both Yoest and Manning oppose, are among the most effective methods for preventing pregnancy. Will the CDC's new messaging withhold or minimize the evidence regarding the efficacy of IUDs because Yoest thinks they cause abortion?
What will become of adolescents who rely on Title X clinics to obtain contraception safely and confidentially? Teresa Manning could push to change Title X guidelines and require parental involvement in teens' health care decisions. While most young people involve a trusted adult in the decision to start birth control, the ones who choose not to often have compelling reasons to do so. I've cared for young people who were cut off financially, disowned, and even physically abused when their parents discovered that they had been sexually active. Mandating parental involvement can place vulnerable adolescents at risk of retaliation by unsupportive parents or guardians.
In 2016, the FDA (an agency within HHS) relaxed the guidelines for the abortion pill, extending the window in which pregnant women can take the medication and decreasing the amount of required doctor's visits. What will happen if HHS's new anti-choice leadership reverses these evidence-based changes? Patients could be forced to make three or more trips to the clinic just to swallow pills in the presence of a provider, or could be made to drive hundreds of miles so that they can take a pill in an ambulatory surgical center (which is essentially a mini hospital). We know that barriers to safe, legal abortion care disproportionately impact low-income women, people of color, young people, and rural women—groups of people who already experience health care disparities.
It's challenging to overstate the potential ominous impact of these appointments on reproductive health. In this hostile climate, it can be easy to slip into despair. As we push back against the administration's repeated assaults on access to abortion and contraception, I hold tight to a vision of what I'd like to see for my patients.
I imagine a world in which people's reproductive decisions are respected and supported. Abortion is routine health care and should be treated as such—fully covered by insurance, including federally administered plans, and available without politically motivated barriers. Every person who wants to prevent pregnancy should be able to choose from a full range of contraceptive options and not be limited by financial constraints. Paid family leave, comprehensive maternity care, birth support, affordable child care, clean air and water, and safe neighborhoods and schools should be a reality for those who choose to parent. Health care policy must be informed by the best available medical evidence, and not ideology or theology.
Diane Horvath-Cosper is an OB/GYN and reproductive health advocacy fellow at Physicians for Reproductive Health.